Pediatric Dental Health

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Is Your Toothbrush Contaminated?
Have you ever wondered what happens to the nasty "bugs" that you brush
off of your teeth? The truth may surprise you. Many of the bacteria, fungi, and
viruses actually remain on your toothbrush! So the next time you use a
contaminated toothbrush, remember that the infectious microorganisms remaining
on the brush can reinfect your mouth and teeth again! Some of the microorganisms
can even spread to the rest of your body.

Children or adults who are undergoing chemotherapy, bone marrow
transplant, or organ transplant procedures.

HOW TO PREVENT TOOTHBRUSH CONTAMINATION:

1. The American Dental Association recommends changing toothbrushes every
three months.

2. Sick children or adults should replace their toothbrushes as soon as
possible - to prevent reinfection, or infection of another person.

3. Children or adults who are immunocompromised, or undergoing
chemotherapy should change their toothbrushes every three days.

4. Always store toothbrushes in an aerated and ventilated environment -
never sealed-up in a closed container.

5. Label and clearly identify each child's toothbrush, so that sharing of
toothbrushes is avoided. Do not let children share toothbrushes!

6. Disinfect all toothbrushes daily.

METHODS OF DISINFECTING TOOTHBRUSHES:

1. Disinfect contaminated toothbrushes overnight in a solution of
household bleach (sodium hypochlorite). Then rinse in clean water, and allow
to air dry. Keep the bleach in a plastic container - not a metal container.

2. Keep all bleach products well out of reach of children! In case of
accidental ingestion of bleach, do not induce vomiting, but give plenty of
water.

3. You can also disinfect toothbrushes by cleaning them in a dishwasher
every night - along with eating utensils. Allow them to air dry afterwards.

A recent article published in Pediatric Dentistry discussed
toothbrush contamination in a day care setting. The article concluded that
toothbrushes can be adequately disinfected by soaking them either in a 0.12%
chlorhexidine gluconate solution (Peridex) for 20 hours, or in a 1 % sodium
hypochlorite solution (1 part bleach, 4 parts water) for 20 hours.

Can We Prevent Dental Caries In Children?
In spite of the current emphasis on preventive dental health, many children
are still affected by dental caries. In fact,dental caries is the most
common chronic infectious disease of childhood. By the age of 6, more than
40% of U.S. children are affected by this disease. Early childhood caries
remains a severe problem in some cultural and ethnic groups. All told, more
than $40 billion is spent each year on prevention and treatment of dental
caries in the U.S.

WHAT IS DENTAL CARIES?

1. Dental caries is a lifestyle-dependent infectious disease.

2. The lactic acid produced by the cariogenic bacteria causes tooth
structure to dissolve. It destroys dental enamel - the hardest material in
the body. When dental decay spreads to the nerve and pulp tissues of the
tooth, the result can be dental pain, dental abscess, or facial cellulitis.

WHAT CAUSES DENTAL CARIES?

1. The oral bacteria responsible for dental caries belong to the
streptococcus mutans and lactobacilli groups of bacteria.

2. These bacteria, which cause dental caries, are able to metabolize
sugar, produce a destructive lactic acid, and produce a sticky dental
plaque. This destructive acid dissolves the mineral structure (hydroxyapatite
crystals) of teeth. If the tooth mineral continues to be lost because of
acid attack, the surface of the enamel will eventually be cavitated,
producing a cavity.

3. The bacteria which cause caries are usually "passed on" from
mother to infant, as early a 10 months of age. The danger of infecting an
infant's teeth is increased if the mother already has the caries disease
herself.

4. Children who frequently consume refined sugar products, such as candy
and soft drinks, have a high risk of developing dental caries. Sucrose, a
type of sugar, is therefore an important contributor to dental caries

5. The newly erupted teeth of infants are the most susceptible to caries
because they are not yet fully hardened (calcified). Calcium and phosphate
in the saliva help fight dental caries by gradually "maturing" the
tooth enamel.

HOW CAN PARENTS IDENTIFY DENTAL CARIES?

1. The first sign of dental caries is a white spot "lesion" on
the enamel surface of the front teeth. These are white, chalky areas, close
to the gum line. These decalcifications are caused by bacterial acid, and
directly precede irreversible loss of tooth structure (a cavity).

2. By "lifting-the-lip" parents will be able to see this early
indicator of caries disease.

3. Parents should get these areas examined by a dentist as soon as
possible, so that treatment can be initiated, if necessary. The white spot
lesions can be "reversed" (remineralized) by the application of
fluoride - if the problem is recognized early enough.

4. Active cavities usually have a golden-brown color.

HOW DOES FLUORIDE PREVENT CARIES?

1. Fluoride contacting the teeth forms a layer of calcium fluoride-like
material on the surface of the tooth enamel. When acid from oral bacteria
accumulates on the teeth, fluoride is released from this protective layer.
This released fluoride then aids in hardening (remineralizing) the enamel.

2. Fluoride inhibits the ability of bacteria to metabolize sugar, because
it interferes with the way bacterial enzymes work.

3. Fluoride inhibits demineralization of enamel, because it inhibits the
breakdown of carbonated hydroxyapatite by bacterial acid.

HOW CAN PARENTS PREVENT DENTAL CARIES?

1. Parents can modify oral hygiene techniques, depending on the child's
age. For small infants, the gums need to be cleaned once or twice a day with
a piece of clean gauze. This will help to establish a healthy oral
environment for the baby teeth. Infants should be introduced to the
toothbrush around the age of one.

2. Parents should not put children to sleep with a bottle containing any
liquid other than water. Parents should encourage their infants to begin
drinking from a cup around their first birthday.

3. Parents should help brush their children's teeth every day, after every
meal.

4. Parents should not let their children drink fruit juice or sweetened
drinks from a bottle or "tippy" cup, since this prolongs the
exposure of teeth to harmful sugar.

5. Parents should provide healthy, balanced meals for children. They
should limit the amount of sugar-laden foods and snacks in their diet.
Plenty of healthy snacks should be available for children. Cheese products
actually fight dental caries.

6. Parents can help make children's teeth more decay-resistant by using an
ADA-approved children's toothpaste. Place only a pea-sized drop of
toothpaste on the toothbrush. Until a child is 3 years old, parents should
only use baby tooth cleanser - to avoid causing fluorosis discoloration of
the adult teeth.

7. Children taking oral medications should have their teeth cleansed after
each dose of medication. Nearly 100% of children's medications contain
sucrose, which can increase the risk of developing dental caries.

8. Children should have their first oral/dental health evaluation by the
age of 12 months, or within 6 months of the eruption of the first tooth.

9. Parents should consider providing children with xylitol-containing
chewing gum, which can help prevent dental caries.

FUTURE TRENDS IN CARIES PREVENTION:

1. Chemotheraputic methods of fighting the caries-causing bacteria will be
used. These methods include the application of fluoride varnish and
chlorhexidine gel on teeth.

2. Vaccines against dental caries. The vaccines would function by giving a
child an improved IgA or IgG immune response to cariogenic bacteria.

3. Molecular probes to measure the level of cariogenic bacteria in a
child's mouth.

5. Laser treatment of teeth. This technique would inhibit the progression
of dental caries by making the enamel surface highly resistant to acid
attack.

The good news is that we can prevent dental caries in children! By providing
a healthy diet, minimizing the consumption of sweets, cleaning children's
teeth at least twice a day, and getting early dental examinations, children
can enjoy a happy, healthy smile.

A recent article in Pediatric Clinics of North America
discussed dental caries. It described methods of recognizing cares, the
epidemiology of dental caries, it pathogenesis, and its clinical management.

Dental Infections In Children
Dental infections are a distressing experience for a child and the parents.
Dental infections in children are usually related to untreated dental
caries. The first indication of an infection is usually oral or dental pain
- often spontaneous. The offending tooth will often hurt during the night.
Any child with a dental infection needs to be promptly evaluated and treated
by a dentist. Prompt treatment will prevent the development of serious
health complications.

WHAT KINDS OF DENTAL INFECTIONS ARE THERE?

1. Acute infection (facial cellulitis). This is a serious and painful
problem. The child may have a swollen face, an elevated temperature, appear
sick, and be dehydrated. This sort of infection can spread to other parts of
body such as the deeper structures of the head and neck.

2. Chronic infection (dental abscess). This problem usually takes longer
to develop. An abscess is really a walled-off infection, and is usually less
serious than a facial cellulitis. A dental abscess feels soft to the touch,
because it is pus-filled. Often, a small localized, swelling is seen on the
gums next to the offending tooth. The offending tooth may be loose or
painful to the touch.

WHAT CAUSES A DENTAL INFECTION?

1. Deep dental caries can infect the dental pulp (the center of a tooth),
and cause a tooth to die (pulp necrosis).

2. When an infection of the dental pulp invades the supporting bone, or
adjacent areas of the face and neck - it results in a true dental infection.
This first step is the inoculation stage of a dental infection.

3. A dental infection is usually caused by a number of bacteria acting at
the same time. Some of these infectious bacteria need oxygen to survive
(aerobic bacteria), and some can't tolerate oxygen (anaerobic bacteria).

4. The first bacteria "on the scene" in a dental infection are
usually the aggressive aerobic bacteria. They cause the development of a
cellulitis, which is a hard, red, tender, warm, and rapidly swelling
enlargement.

5. From the fourth to the seventh day of an infection, the anaerobic
bacteria - which cause a deeper infection- become more numerous. This causes
a central, softened area to develop - which is called a necrotic abscess.
This abscess contains pus - which consists of dead tissue, live and dead
bacteria, and white blood cells.

HOW DOES A DENTAL INFECTION SPREAD?

1. Teeth can carry the infection-producing bacteria deep into the
supporting jaw bone - via the outer root surfaces and inner canals of the
dental roots.

2. Once bacteria have spread to the outer surface of the tooth's roots (periapical/interradicular
area), the infection will spread along the path of least resistance.

3. The most common dental infection in children is the dental abscess,
which is less serious than facial cellulitis. The dental abscess is often
localized in the area of the mouth where the cheek meets the gums (the oral
vestibule).

HOW DOES A DENTIST DIAGNOSE A DENTAL INFECTION?

1. First, the dentist obtains a complete history of the illness, including
the child's symptoms. The symptoms of a dental infections may include: a
toothache, a bad taste in the mouth, bad breath, fever, malaise, and general
discomfort.

2. Next, a physical examination is performed. This can include obtaining
the child's vital signs, examining and palpating the swollen area,
performing an intraoral examination, taking x-rays (radiographs), and
developing a preliminary diagnosis.

3. The dentist will usually take an x-ray of the roots of the tooth (periapical
view), and may also take a dental panoramic radiograph to view all of the
child's upper and lower teeth and jaws (maxilla and mandible).

1. The most important step in treating a dental infection is removing the
source and cause of the infection. This often means: removing (extracting)
the offending tooth. Extracting the offending tooth has the additional
benefit of providing a way to drain accumulated pus.

2. Any accumulated pus needs to be drained from the infected area.
Sometimes, this means that advanced (surgical) drainage procedures will be
needed.

3. Antibiotics are of secondary importance in treating a dental
infection,and antibiotics are not automatically used to treat dental
infections. Antibiotics are used for treating infections involving: rapidly
progressive swelling, diffuse swelling, a medically compromised child, or an
infection that has invaded the extraoral (fascial) spaces.

4. If a child with an infection is dehydrated, IV fluids may need to be
administered.

5. If a child's temperature exceeds 101 degrees F, hospitalization might
be required. Most dental infections in children can be prevented by
obtaining regular dental checkups, and by prompt treatment of any dental
caries.